Transfer of stroke patients impairs eligibility for endovascular stroke treatment

Many patients who are potentially eligible for endovascular stroke treatment (EST) receive intravenous rtPA in the closest stroke unit before being transferred to tertiary centres for EST. It has been shown that clinical outcome of transferred and EST-treated patients is comparable to that of patients with direct access to EST. We analysed clinical outcome of patients, who were transferred and eventually not treated due to clinical and/or radiological deterioration.

We retrospectively analysed our prospectively maintained stroke registry for patients who were transferred for stroke therapy.

Four hundred twenty-two of 1208 patients (35.1%), who were admitted for acute reperfusion stroke therapy between 03/10 and 01/15 were eligible for EST. Ninety-one (7.5%) of these patients were admitted specifically for EST from remote hospitals. Favorable clinical outcome rates after 90 days (mRS≤2) were comparable between 63 transferred and 295 directly-admitted patients, who received EST (P=0.699). However, transferred patients, who were eligible for EST on initial admission, were less likely to receive EST after transfer (P<0.001): twenty-two of 91 patients (24.2%), who were transferred for EST, became ineligible during transfer due to infarct demarcation. Procedural times of treated and untreated transferred patients were comparable (P≥0.508). There was a trend towards worse clinical outcome in untreated patients, without reaching statistical significance (OR, 0.269; 95% CI, 0.55-1.324; P=0.119).

EST should be provided directly whenever possible as one in four transferred stroke patients becomes ineligible for EST during transfer. If direct transfer is not possible, indication for EST should be re-assessed after transfer.